“Feeding struggles affect up to 45% of typically developing children.” – Linscheid et al, 1995
” Feeding struggles affect up to 80% of developmentally disabled children.” – Manlkam & Perman, 2000
“Over a million children nationwide are identified with severe feeding struggles. Thousands more go undiagnosed.” – US Census Data, 2010
Picky eating can be a common phase for most toddlers and children. One day strawberries are their favorite fruit and the next day they never want to see a strawberry ever again; but in a few months they eventually add strawberries back into their diet. This is typical. Other children demonstrate picky eating behaviors that are not typical:
- Feeding has not progressed beyond pureed or soft foods when it is age appropriate to eat table food
- Limiting eating to a short list of foods and/or limiting foods to specific brands
- Demonstrating a strong preference for certain tastes (ex: sweet or salty), textures (ex: pureed, crunchy) or types of food (ex: carbs, dairy) to the strong exclusion of all foods that do not fit with their preferences
- Refusal to try new foods; demonstrating avoidance, anxiety, extreme stubbornness, or emotional outbursts. This is known as food neophobia.
- Negative responses to food may include gagging or throwing up.
- Demonstrating specific or rigid rules about food (ex: foods cannot touch, will not eat certain color foods)
- Motivators (ex: dessert or toys) or punishment (ex: no dessert, no TV) are not successful methods to encourage the child to eat; instead he/she will choose not to eat.
These feeding behaviors are more severe. Even if your child struggles with only one area listed above, if it is affecting his/her nutrition, health, sleep, behavior, attention, energy level, family mealtimes, social situations that involve food, and your parent-child relationship, then it is a problem worth solving. Undiagnosed and untreated feeding issues can lead to bigger feeding issues as many children begin to tire of the foods that they over eat and eliminate them from their short list of foods, resulting in an even more restricted diet. Restricted diets result in nutritional deficiencies that have a huge impact on health, brain functioning, attention, school performance, etc.
“Eating is more difficult than walking or talking.” – Fact presented by BHHS Legacy
Some children have significant anxiety related to eating. This often stems from sensory processing issues, which requires a full evaluation to determine the cause. The anxiety can also be related to previous medical conditions (ex: use of feeding tube or chronic nausea), underlying GI issues or food sensitivities that make eating painful or scary. If a child has a strong gag reflex or hypersensitivity to tastes and textures, eating can be very scary.
Eating involves a complex coordination of movements of the lips, cheeks, tongue and jaw. It involves sensory processing of tactile and taste information along with motor planning to know where the food is in the mouth, how much to chew at one time, how to move it between the right and left side of the mouth, how to chew it sufficiently and create a bolus to then swallow without choking. If there are any problems occurring with any of these areas or skills, it will result in a child with poor feeding skills or a child who refuses to eat any foods other than those that he/she is most comfortable with. Oral motor exercises are critical to improving the strength, awareness, and functioning of the mouth and tongue for successful eating. Children with the following difficulties would benefit from Oral Motor Intervention:
- Loss of food when eating, loss of fluids when drinking
- Difficulty with or unable to drink from a straw and/or an open cup
- Excessive drooling
- Overstuffs mouth with food, spits food out frequently, and/or gags on food; coughs or chokes when swallowing
- Unable to eat food that requires chewing to break the food down; will let foods like crackers and bread break down by using the tongue without chewing
- A baby who is having difficulty with nursing or drinking from a bottle; a baby or child who is tube fed and attempting to transition off of the tube feedings
“Eating is instinctual only in the first few weeks of life. After that, it is a learned behavior. Early intervention is critical.” – Dr. Kay Toomey
Early identification is the key to prevention and an important first step in appropriate assessment and intervention.” – Fact presented by Kemper and Ethel Marley Foundation
It can be difficult for adults to understand the resistance or fear that some children have when it comes to eating. To most adults, eating is an enjoyable experience and over time we have learned to like a wide variety of foods. Fear is not something that we associate with food. But this fear is very real to many children and because it is a primal instinct to protect the mouth and airway, they will put up all barriers to avoid the danger they sense with food. This is why forcing children to eat and using negative consequences and punishment do not work with children who have feeding struggles beyond the typical behaviors. Many well respected individuals may offer this advice: “Only give him what you want him to eat; he’ll eat when he’s hungry.” This may work on the typical child, but a child with feeding struggles would starve himself to avoid the anxiety he feels when confronted with a non-preferred food. This negative approach leads to increased anxiety, continued negative feelings toward eating and food and it breeds mistrust and stress between child and parent. Feeding therapy offers a more positive approach to helping children overcome their issues with food and mealtimes to be able to increase the foods that they will eat over time.
It is critical to identify children who are struggling with feeding as soon as possible. When it can be addressed with intervention in the early stages, many of the learned behaviors, fear, and social-emotional effects can be avoided.